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General NPI Number Information
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NPI Number | 1043769300
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Entity Type | Organization
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Legal Business Name | NEW YORK MEDICAL PRACTICE, PC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 9413 FLATLANDS AVE
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City | BROOKLYN
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State | NY
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Zip | 11236-3726
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Country | US
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Telephone | 646-355-4450
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Fax |
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Provider Business Mailing Address
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Address Line | 565 PLANDOME RD UNIT 286
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City | MANHASSET
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State | NY
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Zip | 11030-1945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHAITANYA KADIYALA
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Credential | MD
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Telephone | 646-355-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | CERT# 4168
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License Number State | NY
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